A recent clinic-based study of 432 Alaska Natives undergoing endoscopic assessment for digestive symptoms estimated similarly high prevalence of stomach pathology in Hp-positive participants [40]; prevalence estimates for Alaska Native patients and Indigenous CANHelp project participants, respectively, were 78 and 97% for active gastritis, 98 and 99% for chronic gastritis, and 13 and 17% for intestinal metaplasia [40]. Here, HP is linked to chronic gastritis.